The Dirtiest Word in Chronic Health Care
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The Dirtiest Word in Chronic Health Care
Our treatment of patients with chronic health conditions often looks more like a wrestling match than a collaboration. But what are we supposed to do with... Read More

I am a nurse with a "chronic illness" And after being dx with MS,I have become a better nurse(emotionally and emphatically) Put yourself in that pts. shoes. Period. Its not hard. Its called EMPATHY. And guess what,Ive become more non-compliant everytime I leave my neurologists office. Just sayin. This article is brilliant and I get it. Walk a mile in my shoes,than tell me,when I was doing everything I Was supposed to do to feel better,eat right,exercise,ect.....That I shouldnt be feeling as bad as I do. Thats when I starting becoming non-compliant.

My brother-in-law chose not to do his insulin for the past few months. Showed up on our doorstep 6 weeks ago with a foot infection for me to "fix" since I'm a nurse. 12 days in the hospital, 2 surgeries to remove all his toes, and then he moved in with us for awhile. He can't go home until he can go up stairs and take care of himself. At first I was emptying his urinal and waking up at 8:00 each morning (after working swing shift) to fix his breakfast. When I didn't get up, he fixed his own breakfast, slipped, bonked his foot and bled all over my floor. He's slowly healing and now sort of walking, but I've spent countless hours helping him over the past few weeks. All because of his noncompliance... oh, excuse me, his choices.

He is now checking his blood sugar and taking his insulin and mostly making good food choices. Thank goodness for that. Please excuse my grumpiness. I need a bit of rest.

You said it well , " All because of his noncompliance" but for the sake of this thread i guess we should say because of " his choices" . I have a question not for you but for those not in favor of " the dirtiest word"
*Now that he understood what was being asked of him and decided to follow on that ..will it be him making new choices? or complying with his diabetic care plan ?

Maybe it wasn't the med itself, but the fact that it was ordered for 0600. Nursing homes are just that--the patient' home. The fact that the doc ordered the pill for 0600 may work for him and for you, but it may feel intrusive and rude to a sleeping patient. That's when you talk to them and find out why they're resisting. Maybe that same pill would be welcomed at 0800.[/quote]

Yes you are saying the same thing i did but in a different way . I was saying i wouldn't chart "non compliant " on a pt who resting taking their 6 am pill b/c i takes time before coming to such conclusion .taking into consideration what you have just mentioned i often did the 1hr before or 1 hr after when passing meds if time appeared to be the problem . So bringing this i.e in my text was to simply show that as Nurses we know .... when a pt is being compliant vs non compliant; base on observation and regular interaction .it usually not an outcome of one nurse experience with the particular pt on one occasion that lead to conclude but often in my experience it was a result of multiple nurses and /or others care givers with one resident refusing care before the word was even considered & used in the chart .

So all of you who are comfortable labelling patients as "non-compliant" because they don't, for whatever reason, follow every aspect of best care for management of whichever chronic illness they have,

- wear sunscreen every day
- never smoke
- don't drink more than the recommended maximum daily amount of alcohol
- have two alcohol-free days every week
- eat whatever the number of fruit and vegetable servings are recommended where you live, every day (here it's two and five)
- choose whole grains over refined grains
- avoid transfats, have minimal saturated fats, and fat comprises less than 30% of your daily caloric intake
- avoid high sugar/low nutrient foods and beverages
- are in the healthy BMI range
- exercise for at least thirty minutes a day, at least five days a week
- have a six monthly wellness medical review, a bi-annual eye test, and a bi-annual breast exam and Pap smear (for women)
- take every dose of every prescribed medication precisely as directed, every time
- wear your seatbelt every time you're in a car and a helmet every time you ride a bicycle, motorbike or quad bike, and
- ensure you have between six and eight hours sleep a night, every night (it's a myth that you can catch up sleep debt)

Because that's the currently recommended best management of living life as an everage Western person. Surely you don't ever choose other practices, even though you know in the longterm they'll increase your risk of complications like cancer and heart disease?

So all of you who are comfortable labelling patients as "non-compliant" because they don't, for whatever reason, follow every aspect of best care for management of whichever chronic illness they have,

- wear sunscreen every day
- never smoke
- don't drink more than the recommended maximum daily amount of alcohol
- have two alcohol-free days every week
- eat whatever the number of fruit and vegetable servings are recommended where you live, every day (here it's two and five)
- choose whole grains over refined grains
- avoid transfats, have minimal saturated fats, and fat comprises less than 30% of your daily caloric intake
- avoid high sugar/low nutrient foods and beverages
- are in the healthy BMI range
- exercise for at least thirty minutes a day, at least five days a week
- have a six monthly wellness medical review, a bi-annual eye test, and a bi-annual breast exam and Pap smear (for women)
- take every dose of every prescribed medication precisely as directed, every time
- wear your seatbelt every time you're in a car and a helmet every time you ride a bicycle, motorbike or quad bike, and
- ensure you have between six and eight hours sleep a night, every night (it's a myth that you can catch up sleep debt)

Because that's the currently recommended best management of living life as an everage Western person. Surely you don't ever choose other practices, even though you know in the longterm they'll increase your risk of complications like cancer and heart disease?

I won't. Ever! If my pt.,drank 4 vodka's a day,smoked a pack of cigs,had open heart,comes home,recovers nicely,is retired,Misses his old routine/habit's of having his nightly vodka and cigs,I say,go for it.Ive seen this type of pt. go down if their old routine is not resumed. To expect someone like vodka/cig/retired guy,to not go back to his old routine and be compliant compliant compliant, is soooooooooooo completely unrealistic. Ive seen the the vodka/cig/retired guy try to be fully compliant,and their spirit,zest,ferver for life is zapped and they go down quickly. Thats when I talk to them human to human,and tell them "I understand,tht must be hard" Ive talked to the docs,and have several docs agree with me,and vodka/cig/retired guy...is told,have a vodka,maybe TRY to kick the cigs,but above all,for godsakes,enjoy your life,and guess what?.....Vodka/cig/retired guy....may decided he does want to stop vodka/cigs. Regardless,he is still a human. When a pt. is non-compliant,lets be honest with ourselves,its not about them,its about you. They get on YOUR nerves,YOU feel like YOU are working and getting nowhere so YOU are burnt out. As I said in an earlier post...I am a nurse with a disability,and after my disability,ive become what every nurse should be. EMPATHETIC. Put YOURSELVES in THEIR shoes.

I had about a 12 year honeymoon period, where (after my initial diagnosis with an A1C of 10.2, a random bg of 389) I had to go on insulin. My endocrinologist at the time (and for a long time now, "Ex" endo) refused to deal with a trend of my A1C creeping up. I asked to go on insulin after about 6 months of metformin made me sick. She said no- and wanting to be proactive, and not reactive, I left her- fast. Finally, the NP who was dealing with my warfarin dose gave me a Lantus starter kit, and a prescription for NovoLog- she explained the carb counting and insulin:carb ratio- and told me it would take some finagling to get it right. NO KIDDING. I went to a dietician, who hadn't been updated since about 1943- she was useless. So, I was basically on my own, to do pre/post prandial and hs blood sugars, and work with the NovoLog to find what worked to get my 2hour sugars "ok"....my Lantus dose was adjusted per my fasting am sugars. It's NOTHING like having a diabetic patient in the hospital, and having some nice sliding scale to go by. Fortunately, I'm not too stupid. I did have some nasty lows (and found out how useless the ED was), and eventually got it all figured out. THEN, enter chemo- that threw things off for this last year- like WAY crazy. It's been a crapshoot. But, fortunately it's coming back down to my usual FBS of <90mg/dl. I've got several chronic disorders; diabetes is about the only one I've had any sort of handle on. But it's a mess at first. I'd been an RN for 22 years when I started insulin. That saved me. I feel bad for those in the community who are left with a few brochures and a questionably useful dietician (around here, anyway). JMO

I was diagnosed with diabetes about 8 years ago. I had gestational diabetes and it just never went away. I have no insurance. So basically, no one really cares whether my blood sugar is controlled or not. When I was diagnosed, I was handed a prescription for Metformin and was told to come back in a year. My sugars are not too great because all those medications require prescriptions and some of them are expensive. If I were to end up in the hospital, I would probably get labeled noncompliant.

Many dieticians are woefully behind the times. The ADA diet is not the "magic bullet" some medical folks seem to think it is. If you are hospitalized with, say, a cardiac problem (a common occurrence with diabetes) the combined ADA/AHA diet is so restrictive as to be laughable. Two egg whites on a lettuce leaf is a recipe for "noncompliance."

Many diabetics do well on a modified Atkins diet (includes more fruits and veggies than the original) and I think the Atkins people themselves have altered the diet some. A low-starch diet, rather than a low-carb diet is similar and helps diabetic patients feel like they can actually have a satisfying meal. Low starch means you eliminate white potatoes, white rice, pasta, white bread and you have only small amounts of sweet potatoes, brown rice, whole wheat pasta and whole grain bread. But you can have meat, eggs, dairy and all manner of vegetables and most fruits. You can even have a small amount of sweets in your diet in the form of gelato or flourless desserts. A diet is doable if you don't have to be hungry.

Most dieticians gasp when they think of this. Eggs? Meat? Dairy? What about all that cholesterol? New research has found that dietary cholesterol and serum cholesterol do not correlate directly as once was thought. Our bodies produce cholesterol even if we don't eat eggs or meat. Why? Because we're animals and animals make cholesterol.

The ADA diet (especially if combined with the AHA diet) can make people crazy. And hungry. But this is still what's being trotted out and handed to patients as if it were etched on a stone tablet delivered from the heavens. Fortunately, there are some dieticians who listen. I know of one patient whose HA1c dropped two full points in four months on a low-starch diet. That dietician was amazed and said she would be checking out the latest research.

The ADA diet is a tiny wagon that's easy to fall off. And this is only one of the crazy-making aspects of diabetic care. Is it any wonder that many diabetic patients rebel?

I hope that dieticians will be given updated information and feel energized by the changes. But something tells me that it's going to be years before that happens. The old ADA diet will continue to be the sacred cow of many instead of being turned into burgers and steaks that are a wonderful part of a low-starch diet.

Many dieticians are woefully behind the times. The ADA diet is not the "magic bullet" some medical folks seem to think it is. If you are hospitalized with, say, a cardiac problem (a common occurrence with diabetes) the combined ADA/AHA diet is so restrictive as to be laughable. Two egg whites on a lettuce leaf is a recipe for "noncompliance."

Many diabetics do well on a modified Atkins diet (includes more fruits and veggies than the original) and I think the Atkins people themselves have altered the diet some. A low-starch diet, rather than a low-carb diet is similar and helps diabetic patients feel like they can actually have a satisfying meal. Low starch means you eliminate white potatoes, white rice, pasta, white bread and you have only small amounts of sweet potatoes, brown rice, whole wheat pasta and whole grain bread. But you can have meat, eggs, dairy and all manner of vegetables and most fruits. You can even have a small amount of sweets in your diet in the form of gelato or flourless desserts. A diet is doable if you don't have to be hungry.

Most dieticians gasp when they think of this. Eggs? Meat? Dairy? What about all that cholesterol? New research has found that dietary cholesterol and serum cholesterol do not correlate directly as once was thought. Our bodies produce cholesterol even if we don't eat eggs or meat. Why? Because we're animals and animals make cholesterol.

The ADA diet (especially if combined with the AHA diet) can make people crazy. And hungry. But this is still what's being trotted out and handed to patients as if it were etched on a stone tablet delivered from the heavens. Fortunately, there are some dieticians who listen. I know of one patient whose HA1c dropped two full points in four months on a low-starch diet. That dietician was amazed and said she would be checking out the latest research.

The ADA diet is a tiny wagon that's easy to fall off. And this is only one of the crazy-making aspects of diabetic care. Is it any wonder that many diabetic patients rebel?

I hope that dieticians will be given updated information and feel energized by the changes. But something tells me that it's going to be years before that happens. The old ADA diet will continue to be the sacred cow of many instead of being turned into burgers and steaks that are a wonderful part of a low-starch diet.

Haha, yes. My visit to a dietitian included these instructions: Don't drink anything carbonated, even diet sodas, and avoid anything with corn. The end.

I was diagnosed with diabetes about 8 years ago. I had gestational diabetes and it just never went away. I have no insurance. So basically, no one really cares whether my blood sugar is controlled or not. When I was diagnosed, I was handed a prescription for Metformin and was told to come back in a year. My sugars are not too great because all those medications require prescriptions and some of them are expensive. If I were to end up in the hospital, I would probably get labeled noncompliant.

I wouldn't. Ever. I would EMPATHIZE you. A. Insurance-smurance. Thats sucks fo you,and I have had many pts. without insurance,can't speak english,I am homecare so i see them when they come home....Paralyzed from nipple line down,spanish speaking,no insurance,I call the docs said pt. saw in hospital and than in rehabilation facility,pts. rx are running out,no pcp,get social work involved who EMAILS spanish speaking pt. form to get started on medicaid/medicare,they can't read English. Several phone calls later,thee doc has nothing else to say to except label that pt. non-compliant!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! As I said before and I will say it again. EMPATHY!!!!!!!!!!!!!!! Where is the humanity in healthcare????? Non-compliant,compliant,icd9...Its all a bunch of BS and I believe Florence N. is screaming from the sky. I don't know bout any of you other nurses,but I often wonder,how I can sleep at night. And most of the times I can't. Labels like non-compliant and compliant borders on the edge of being slightly self-important and sociopathical. Crazierthanyou,if I were some a-hole millionare making money to do put a ball in a whole on the grass or read some lines from script and pretend to be someone else,I'd take care of you.But,Im not a millionare for doing basically nothing,I would never,ever LABEL you. Thats not why I became a nurse. Wow. I sound like my hero,George Carlin?!?!?!?! hahahahahaha.